Provider Demographics
NPI:1063948800
Name:GARCIA, CARLOS RENE (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:RENE
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3042
Mailing Address - Country:US
Mailing Address - Phone:713-906-6521
Mailing Address - Fax:
Practice Address - Street 1:4242 MEDICAL DR STE 1260
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5641
Practice Address - Country:US
Practice Address - Phone:210-615-1187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT1942207L00000X
TXBP10060839207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology